Term Paper On Community Health Nursing

Term Paper On Community Health Nursing

Community Health Nurse
A community is defined as a group of people that work, live and play in a particular environment at any given time. This group of people share common attributes and interests. Therefore a community assessment can be elaborated to mean the process of collection, analysis and use of data to facilitate a change in the collective health of a community. The process involves developing proprieties, assemblage of resources and the elaboration of a plan of actions garnered towards the improvement of the health system of the community.
In this paper, a community health assessment would be done in the Scarborough community in Toronto with the aim of developing an action plan that would be beneficial to the people of the community in order to improve their health.

Community Assessment
The Community – Demographics
Immigrants and their descendants make up a large chunk of inhabitants of Scarborough. According to the 2006 census figures, 57% of inhabitants are born in foreign countries. Minority populations make up a whopping 67.4% of the population.
Scarborough is one of the four community councils in Toronto. It has a total population of 625, 930 according to 2011 estimates. This represents a 3% increase from the 2006 population census figures. There are four major types of housing structures utilized by the people of the community. 51% of the inhabitants of the community live in houses, as compared to 37.6% of inhabitants of Toronto; while 33.7% of the inhabitants of Scarborough live in apartment building that have five or more storey compared to 41% of Toronto inhabitants that live in similar houses. Moreover, 6% of inhabitants of the community live in buildings less than five storey as compared with 15.6% of the total inhabitants of Toronto that live in similar housing conditions. Furthermore, 9.3% of inhabitants of Scarborough live in row or town houses as compared with 5.8% of the total inhabitants of Toronto that live in similar conditions. Also, according to the 2001 population estimates, the age group 45 to 64 years of age constitutes the highest percentage of inhabitants of scar, with about 24% of the inhabitants which is closely followed by the 24 to 44 years age group. This shows that the population is an active one with a lot of individuals falling within the active workforce age group. A survey of the size of households also indicates that one-family households constitute 70% of household types. moreover, a survey of household sizes also indicate that 2 person households constitute the highest group of household sizes with 26.7% of the population being within this group, this is closely followed by the 4-5 person households which has about 26.6% in this group.

Scarborough has as its borders; Lake Ontario on the southern end and at the western part, Victoria Park Avenue borders it. The north is bordered by Steels Avenue East, Pickering and the Rogue River. Lake Ontario borders it at the southern end.

Scarborough is a large city characterized by cultural diversity.
The Economy of Scarborough is akin to that of Toronto, because Scarborough is section of the former Toronto. Industrial setting is said to be similar in all the categories of the labor force. The manufacturing industry has a higher percentage in Scarborough than in Toronto. However, the segment of the working population which are professionals, including workers that provide scientific and technical services are also lower when compared to the proportion of the working population of Toronto. Several manufacturing corporations have their headquarters in Scarborough.

Scarborough is home to a diverse range of religions and places of worship. This is not farfetched considering the fact that the people that reside in the city come from a wide range of cultures that have a strong religious affiliation to their cultures. Religions that have a strong presence in Scarborough include Christianity of which Catholicism is the most prominent, Islam and Buddhism.

Community Diagnosis
Target Population
The target population that I will be writing about include the group of individuals that are at risk of Type II diabetes Mellitus. Although there is no age limit to the development of Type II diabetes Mellitus, the elderly population especially those people aged 65 years and above are especially susceptible to the disease condition and its attending complications.

Health Issue
The old adult age group is contributing an increase in the proportion of individuals with Diabetes in the general population. This would no doubt lead to the increase in the incidence of complications attributed to diabetes. Vascular complications remains the most common widely known complication of diabetes mellitus. However, the risk for cognitive impairment, physical decline, depression, falls and fractures have also been highlighted as serious complications that the elderly can suffer from having type II diabetes mellitus. It is therefore important that clinicians and public health professionals alike find a solution to the scourge of diabetes mellitus in the elderly so that the quality of life of these older adults would be optimized. Diabetes Mellitus has become a major chronic medical condition that has gained epidemic dimensions in developed countries, of which Canada is one of them. (Harris et al, 1998) in fact it has been said that the epidemic dimensions which diabetes mellitus is assuming is posing a threat to undoing the success made in the management of coronary artery disease and cerebrovascular accident which have been made over several decades in the past.(Geiss, 1997). As it has been mentioned earlier, Diabetes Mellitus affects all age groups. However, the highest absolute increase in the prevalence of diabetes is seen among the elderly (aged 65 years and above) (Boyle JP et al, 2001). at present, 42% of individuals with Diabetes Mellitus in the United States include the age group above 65 years and there is a projection that this figure will increase to 53% by 2025 and will further increase to 58% by the year 2050 (Boyle et al 2001).

The Cause for the Health Issue
The increase in the incidence and prevalence of Diabetes mellitus among the elderly population should be a source of concern (Edward & Brown, 2001). This is because dangerous complications of the disease including hypoglycemic and hyperglycemic events, vascular complications, loss of vision, renal impairment and failure, development of foot ulcers and some other cardiac complications are all recognized complications of diabetes mellitus. moreover, in addition to all these well known complications of diabetes mellitus, cognitive decline, falls and fractures, physical disability and other geriatric medical conditions all have a link with diabetes mellitus (Gregg et al, 2002),(Strachan, 2003) . Therefore, the need to manage the disease appropriately in the elderly cannot be overemphasized. This disease has a direct effect on the quality of life of the elderly.
Diet control is an integral aspect of the management of Diabetes Mellitus. However, in the elderly, this mode can pose a great challenge to the managing physician. This is because the elderly have unique problems that can impair their nutrition. the absence of teeth or well fitting dentures, the inability to afford food that is nutritious, the inability to understand instructions on the appropriate diet to take are some factors that can make dietary compliance difficult for the elderly. Moreover, some social factors like living and eating alone, which would reduce the motivation of cooking an elaborate meal, or leading to the decision to eat food that has a high calorie and fat content, may all interfere with maintaining a proper diet which is central to the control of diabetes mellitus in these individuals. Moreover, other factors like impaired perception of taste (most especially the sense of saltiness or sweetness) may lead to over-sweetening or over-salting food. (Bohannom, 1988).

Signs and Symptoms of the health issue
Signs and Symptoms of dietary indiscretion in patients with type II diabetes would include frequent episodes of hyperglycemic and hypoglycemic events. Also Diabetic Ketoacidosis is a dangerous complication of Diabetes that the elderly are particularly prone to. Moreover, an increase in the prevalence and severity of the complications of diabetes in the elderly, including cognitive decline, falls and fractures, physical disability among other things, would point to uncontrolled blood glucose (Gregg et al, 2002), (Strachan, 2003).

Strengths of the Community
Scarborough is a community that has strong cultural values. The community is home to a large number of individuals of foreign nationality. This fact fosters a strong sense of belonging among the individuals of each ethnic subgroup. This is a strong point because individuals in this subgroup have a strong sense of family and are always ready to support each other through whatever they are going through.
Moreover, as part of benefits of living in a diverse community, there is high level of tolerance among the members of the community and they readily accept each other. Because of this, it is easy for members of the community to come together to achieve a common purpose. In this case, cooperating to improve the health of the community will not be a strange thing for members of the community.
Another strength that the community possesses is its deep religiousness. The different cultural groups have a strong affiliation to the various religions that they practice. Because of this, it will not be too difficult to approach each sub-culture through their religious groups.

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The Health Care Market Essay Example

The Health Care Market Essay Example

Qn 1
Access to health care services varies from state to state. In the U.S, healthcare services have tremendously evolved from a predominantly volunteer or charitable system where patients paid little or no money at all to business entities (Ameringer, 2008). The healthcare industry is now one of the largest industry employing over 13 million workers with a projection to increase by 5 million by 2015. According to Ameringer, its very unfortunate that the health system problems lie with delivery system that drives low quality and inefficient care in a country filled with latest technological advancements and skilled health care professionals. Health care professionals working in the same area and on same patients are not connected. Current private and public healthcare payment model each contains its set of rules and payment methods that further degrade the health care delivery system (Ameringer, 2008).
The major determinants of health care delivery system is the cost that is associated in delivering the health services. Health plans and policies pressured insurers and hospitals to cut costs and lower payment rates to assume the financial risks for patient’s care (Organization, 2013). Insurers later abandoned the tightly managed care practices and created a broad provider network, which targeted employer-sponsored insurance. This ensured the health providers were covered from the cost of offering the healthcare services. Another strategy that was employed by the health care providers was shifting the attention from wholesale health services to retail services, preferring to deal directly to the patients on the basis of the latest technology and amenities. Private health provider conquered the hearts of many patients in terms of the trust and better health services, and this led to an alarming rise in the cost of providence.

Qn 2
The main competitive forces in the health care delivery system focus on value based competitions. The value for patients and not just lowering the cost of health care services but the competition should be a result oriented. The competition should be centered on medical conditions throughout the full life cycle of health care delivery. In addition, the cost of high-quality care should be less expensive. The value of health care service delivery should be driven by provider scale, learning and experience at the medical condition level. The height of competition should not only be local but national and regional. Information on delivery services should be widely available, with creative innovations on medical research be handsomely rewarded to promote more bright ideas.
The level at which healthcare services are rendered determines the cost and prices of the services. An insurer offering excellent services with highly skilled medical personnel tends to offer higher medical prices for its services more than the average health care insurer. The supply and demand of services are more affected by the service delivery. For instance, if the services offered are good, and the cost is low, the supply and demand of the healthcare services will be high.
The quality of care is determined throughout the full life cycle of healthcare delivery. Issuers offering high quality of services accompanied by skilled professional in the field will always have the best quality of care. The level of health care consumer or patients is always high on areas with good quality services as this entrust the patients with better services provided and a quick response to their ailments. The variety of services offered, a high number of patients requesting their services and the cost of services can compensate providers. If the service delivery is good and the cost is low, more patients will flock the healthcare, and that will compensate the providers in terms of more payments done.

Qn 3
Managed healthcare is a system of health care delivery that is managed by a company whose main aim is to act as an intermediary between the health service providers and the patients. It was introduced with the intention to avoid paying for unessential services and facilities directly to health service providers. The main aim was to see quality and cost effective services rendered to patients at affordable prices without limiting or restricting the patients choice of physicians or the physicians limiting their fees. This helped in monitoring the cost-effectiveness of services being utilized. HMOs provides preventive and integrated care services to voluntarily enrolled families and business entities with low insurance covers on their network of hospitals and doctors that belong to the organization. Families were offered the chance to have a personal doctor or physician which they could not afford if they seek medical services on their own.
HMOs has help revolutionized the health sector in curbing emergency cases especially cases related to infants, childbirth and pregnancies and access to specialty care for children chronic illness. As enrollment increases in HMOs, so is the need for methodological sound studies on the effect of these arrangements on the health outcomes.
The main disadvantages of HMOs is that not all enrollees utilized the services of HMOs. Some HMOs consider pediatricians for children but are associated with higher primary rates per visit. In addition, before a diagnostic service or seeing a specialist, a referral is required, which is not covered with the HMOs. This is quite a disadvantage as all, or most of the costs will be catered for by the individual while the main aim of enrolling to HMOs was to lower cost. According to recent studies, when provider payments are capitated, HMOs are linked to a decrease in preventive visits.
The other major disadvantage is the rate of uninsured and the underinsured people. The uninsured are not under any medical cover, and the underinsured have limited coverage that do not shield them from additional cost. The managed Care seem to favor the insurance carriers more than the patients or the health providers. Providers take a huge risk and have to participate in the insurance plans for their business to succeed (Halverson, 1998).
The limitations on HMOs are less compared to the numerous advantages it has. The disadvantages can be in that HMOs offer little few doctors in which patients can choose from, the possibility of under treatment, restricted coverage, and compromised privacy. HMOs affects nursing by creating significantly few jobs openings for the registered nurses creating a vacuum of unemployment for qualified nurses. In addition, there is a rise in use of advanced practice nursing and non-acute health care settings.

Qn 4
The health care system’s financial incentives are not geared to offer rewards to efficient and effective medical care. The payment system offers fee for service and the hospitals; doctors and service providers are for the services rendered. Unfortunately, when the health care is efficient, all the savings go back to the federal government, the insurance company and the player rather than a hospital. The total amount in dollars spent on health care in the US reached $2.6 trillion or $8402 per person in 2012 (WHO, 2013). Consumers are attributed to lower expenditure as they continue to remain cautious on spending due to the loss of private health insurance, lower income, and fear of their financial future. The spending of physicians, prescriptions and hospitals are at their lowest. For the patients, this has amounted to a decrease in out of pocket expenditure and a decline in health care spending on overall growth.
Healthcare services expenditure has a slow response on recession, and this is because healthcare contracts and insurances are negotiated earlier or in advance. For instance, the slow response to the recent recession was attributed to several factors like loss of insurance, the unemployment rate and lowest inflationary adjusted income in several years (Getzen & Allen 2007) The labor force has an effect on the healthcare system, educating and training health care workers and offering them incentives like favorable work conditions, occasional trips and retreats offer the healthcare an advantage to perform better.
The healthcare industry offers many opportunities in terms of job opportunities and Physicians are well paid in the fields of surgery. According to recent research, the amount of money offered to doctors and physicians is considered peanuts to what they undergo in their respective fields. Proper incentives and reviews should be done to motivate another breed of doctor and physicians. Emergency of new social and lifestyle diseases calls for new research and proper funding.

Qn 5
Capitation methods were popular in the early years of health reforms, a method of paying physicians for cost containment measures in the healthcare organizations. Recent study of the decline of the capitation in the recent years as a form of payment to for physicians was noted with facts and figures. More emphasis has been laid on the integration of different payment systems with the implementation of healthcare reforms. Restructuring physicians should include some form of capitation incorporated with other ways of payment.
Physician payment using capitation can be a more effective way of controlling healthcare costs because it allows for the prediction of costs for healthcare services more accurately by both the employer and insurer (Ger, 2011). When using the capitation method of payment, the medical delivery system is given the financial risk of caring for the patient. It is necessary for the health care system to have a cost accounting system, or develop cost information on each person paying and the service line prior to signing a capitation contract.
Health providers assume that for any insured people, the provider will be obliged to cover all health care services for a fixed amount for a member as per the capitation contract. The capitation contract could cover full continuum of services, including specialty physician visits, primary care physician visits, home health visits, acute hospital stays, tertiary physician visits and outpatient’s visits. The payment must be acceptable for both the insurer’s point of view and the delivery system or providers. The insurer is always limited by what the consumer can afford to pay for the health insurance services. In addition, the health care managers are to be informed of the per capita cost to the insured persons and compare the cost to what the insurer is per capita per month.

Ameringer, C. (2008). The health care revolution from medical monopoly to market competition. Berkeley: University of California Press ;.
Ger, P. (2011). Physician payment mechanisms an overview of policy options for Canada. Ottawa, Ont.: Canadian Health Services Research Foundation.
Getzen, T., & Allen, B. (2007). Health care economics. Hoboken, NJ: John Wiley & Sons.
Halverson, P. (1998). Managed care and public health. Gaithersburg, Md.: Aspen Publication.
Haugen, D. (2012). Health care. Farmington Hills, MI: Greenhaven Press.
Inequalities (The) a Resource Book. Geneva: World Health Organization.


Public Health Problem Research Paper Example

Public Health Problem Research Paper Example

Description and Analysis of Specific Public Health Problem
HIV/AIDS used to be a disease that was rendered incurable due to the fact that there was no treatment back then. In fact, it is notable that the diagnosis of HIV/AIDS ultimately served as a “death sentence” (Lopez, 2011), mainly because of the fact that the patient is left without any options to prolong his life. However, the development of HIV/AIDS treatment has now lead to the transition of HIV/AIDS from being an acute cureless disease to a chronic one that can be countered with specific medications. Such, of course, served as a welcome development to HIV/AIDS patients, who have also long suffered the debilitating effects of the disease on their immune system, which left them vulnerable to complications. Nevertheless, a slew of findings have shown that HIV/AIDS treatment has introduced complications among patients never before seen or even foreseen by healthcare practitioners. That, of course, leads to the question on whether it is proper to allow the continuous delegation of HIV/AIDS treatment to patients or initiate developments designed to attack said complications. Lopez (2011) promptly argued that new developments to treating HIV/AIDS must be introduced, given that many of the complications arising from HIV/AIDS treatments arise from specific lifestyle problems arising from society. Complications arising from HIV/AIDS treatments are a social problem, not least because of the impact of lifestyle problems, which affect society at large. Moreover, the continued prevalence of HIV/AIDS worldwide provides the findings of Lopez (2011) on HIV/AIDS patients in the United States (US) with great social significance, given that it casts doubts on the integrity of current healthcare practices with regard to HIV/AIDS treatment.
Initially regarded as an acute disease, HIV/AIDS has had no known treatment, leading patients to regard the diagnosis as a death sentence, with no chance of prolonging their lives. However, the introduction of new treatments for HIV/AIDS has made longer life expectancies for patients possible. HIV/AIDS treatments such as nucleoside reverse transcriptase inhibitors (NRTIs), non-NRTIs, and high active antiretroviral viral therapy (HAART) all provided new hope for HIV/AIDS patients, who now enjoy a high chance of possibility towards full recovery. Nevertheless, there is an understanding that complications, mostly in the form of lifestyle effects side effects, have since emerged among patients – a phenomenon never encountered before by healthcare practitioners. Lifestyle patterns among HIV/AIDS patients, including smoking and poor diet leading to diabetes, have aggravated their health conditions to extents incurable by current HIV/AIDS treatments. At the same time, HIV/AIDS treatments have been found to cause side effects on patients as well, such as myocardial infarction (MI) and cardiovascular disease (CVD). Since HIV/AIDS treatments are not exactly designed to counter complications, the compelling need to introduce new improvements have now emerged as a means to keep the integrity of healthcare practices on HIV/AIDS intact, to the full benefit of patients, specifically those in the US (Kirton, 2008; Lopez, 2011)
As a public health issue, one could not deny the importance of solving the problem of HIV/AIDS treatments with regard to complications. HIV/AIDS continues to threaten people worldwide and it may cause severe consequences to communities, from mismanagement of treatment delegation to discrimination of patients in certain everyday activities. Therefore, even if current HIV/AIDS treatments can prolong the life expectancies of people, the complications that have since emerged from patients now stand as a compelling issue in public health healthcare practitioners must seek to resolve (Lopez, 2011).
As consistently mentioned, the etiological factors for HIV/AIDS treatment complications include the aggravating effects of lifestyle practices of HIV/AIDS patients and side effects coming from current forms of HIV/AIDS treatments – NRTIs, NNRTIs and HAART. Smoking, a lifestyle problem of HIV/AIDS patients, can cause a slew of diseases that include leukemia, cancer, CVD and many others (Lifson et al., 2010). NRTIs, NNRTIs and HAART could lead to heart-related complications such as MI and CVD, given the inflammatory nature of HIV/AIDS. Also, NRTIs, NNRTIs and HAART could also cause diabetes due to insulin resistance and glucose level anomalies. Lifestyle effects, such as poor diet leading to obesity, are also found to have led to MI, CVD and diabetes among HIV/AIDS patients in the US (Formulary Staff, 2010; Kirton, 2011; Lopez, 2011).

Solving the Public Health Problem
It is also important for healthcare practitioners in the US to become more information towards patients with regard to detailing preventive measures against HIV/AIDS treatment complications. For one, it is crucial to tell patients to undergo specific therapies, such as lipid-lowering therapy, in order to mitigate MI and CVD. Healthcare practitioners must also monitor the state of obesity among HIV/AIDS patients in order to prevent instances of diabetes. The use of HIV/AIDS treatments from different classes not known to cause CVD must also be considered by healthcare professionals in order to enable HIV/AIDS patients to avoid HIV/AIDS treatment complications (Lopez, 2011).
Moreover, it is crucial for healthcare practitioners to prepare HIV/AIDS patients in the US with regard to new kinds of HIV/AIDS treatments. For new HIV/AIDS treatments to become more effective, healthcare practitioners should first make sure that HIV/AIDS patients are willing and knowledgeable to take those. For that, healthcare practitioners must teach HIV/AIDS patients to deal with possible complications both from the treatment and HIV/AIDS itself. It is also crucial to develop new programs designed to address HIV/AIDS treatment complications, which in turn could make sure that HIV/AIDS patients exert full compliance (Kirton, 2008; Lopez, 2011).

Public Health in the Future
As specified in the literature, it is highly important to curtail the negative effects of HIV/AIDS treatment complications, specifically among HIV/AIDS patients in the US. Given the fact that HIV/AIDS treatments have since led to lengthening the life expectancies of HIV/AIDS patients, it is also imperative to protect them against complications in order to prevent making their new lease in life an ordeal for them to endure. As a public health problem, HIV/AIDS treatment complications need to be countered efficiently through delegation of proper remedies, as stated earlier. Yet, as it stands, it is important to emphasize that prevention is, indeed, better than cure when it comes to dealing with HIV/AIDS treatment complications (Kirton, 2008). To prevent HIV/AIDS treatment complications from emerging, it is important for healthcare practitioners to impose strict regimens for HIV/AIDS patients undergoing treatments. The use of NRTIs, NNRTIS and HAART, provided those do not introduce side effects, must come with proper lifestyle practices such as the consumption of suitable dietary regimens and prevention of smoking. Healthcare practitioners must exercise greater authority to prevent activities that may just aggravate the health of HIV/AIDS patients. At the same time, it is also important for healthcare practitioners to monitor HIV/AIDS patients constantly while undergoing treatment until such time that they have recovered to the strongest extent (Lopez, 2011).
My personal experience with HIV/AIDS treatment complications comes from an acquaintance, who is currently an HIV/AIDS patient. While my acquaintance has contracted HIV/AIDS through unsanitary hospital equipment, his habit of smoking and poor diet has led him to suffer from complications. Even prior to contracting HIV/AIDS, my acquaintance has since been a heavy smoker and drinker, which is why it became really difficult for him to become an HIV/AIDS patient, given that he had a really hard time sacrificing what he has been used to doing. Therefore, for people like my acquaintance, I could really see why it is very important for them to get new kinds of treatment and other measures that could enable them to deal with HIV/AIDS treatment complications. Indeed, it is not all the time that contracting HIV/AIDS is due to circumstances that could have been prevented by the patient himself, such as in the case of sexual intercourse. Improper medical practices delegated by healthcare practitioners, which is understandably beyond the control of individuals, could cause HIV/AIDS and patients would, of course, be forced to stop whatever practices they are used to doing. Nevertheless, I am of the belief that with HIV/AIDS or not, avoiding unhealthy practices is something that healthcare practitioners must promote to protect public health.
In the future, I am of the opinion that healthcare practitioners in the US must maximize their capabilities to prevent HIV/AIDS treatment complications. From preventive measures to innovative practices that include the creation of new kinds of HIV/AIDS treatment, protecting the welfare of HIV/AIDS patients must serve as the primary goal. Understanding the causes of HIV/AIDS treatment complications serves as perhaps the first and most important step for healthcare practitioners and HIV/AIDS patients in the US alike. At the same time, keeping healthy at all times must serve as the primary goal of HIV/AIDS patients, given the gravity of their situation. HIV/AIDS patients in the US must also receive adequate assistance from healthcare practitioners, who in turn must exert competence in what they do so that they could ensure their smooth recovery. For healthcare practitioners specializing in producing HIV/AIDS treatments, they must make it a point to take into consideration the different kinds of complications that patients experience. In that way, healthcare practitioners would be able to introduce highly effective HIV/AIDS treatments. All of the foregoing recommendations must find bearing in future studies.

Formulary Staff. (2010). Some antiretroviral drugs used to treat HIV associated with an elevated risk of myocardial infarction. Formulary, 45(9), 292
Kirton, C. (2008). Managing long-term complications of HIV infection. Nursing 2008, 38(8), 44-49.
Kirton, C. (2011). HIV: The changing epidemic. Nursing 2011, 41(1), 36-43.
Lifson, A., Neuhaus, J., Arribas, J., van der Berg-Wolf, M., Labriola, A., and Read, T. (2010). Smoking-related health risks among persons with HIV in the strategies for management of antiretroviral therapy clinical trial. American Journal of Public Health, 100(10), 1896-1903.


Example Of Pre Hospital Care Essay

Example Of Pre Hospital Care Essay

Question 1
One of the aspects that can help in identifying a patient’s pain is any past use of painkillers. The ambulance officers only asked about any pain killers that the patient had taken. Although they did not enquire about any health problem that could have been the probable cause of the pain, Mrs. Markantonakis informed that ambulance officers that the patient had a heart problem. The ambulance officers were also informed about the hospitalization of the patient. His wife mentioned that Flinders Medical Centre was his preference since most of his notes and records pertaining his health were there. The respondent of most of the patient’s medical history questions, Chrisoula (his daughter), did not have much knowledge about the health of her father in the past. She could not recall her father having a motor vehicle accident reportedly in July 2002 in which he had suffered both neck and shoulder injuries (pp. 4). She could not even recall of him receiving any physiotherapy. His wife later admitted to the fact that the patient had physiotherapy after the accident. The officers did not examine the patient. The patient’s wife was able to disclose the time when the pain had started i.e. shortly after midnight on 6/03/2004. They tried to relieve his pain by using pain killers namely Panadeine Forte which did not work for him.

Question 2
The following variables would be included in the diagnosis:
– Physical: This includes its location, spatial distribution, as well as its symptomotology
– Cognitive and behavioral factors include the number of doctor visits and hospitalizations, drug usage, verbal as well as nonverbal behaviors
– Affective or emotional factors include depression and anxiety
– Functional measures: Include uptime, and productivity
– Economic factors include costs and lost workdays
– Social and cultural factors include independence, productive family involvement, quality of life, and patient goals.
For collecting this information from the client, I would use a combination of questionnaires. First I would seek to get the physical descriptors of pain intensity and qualities using the McGill Pain Questionnaire (MPQ). This would give me the details about the physical sensation of the pain, its intensity, the anatomic location and radiation pattern, the current severity, as well as the frequency or rather the occurrence (Vercellini, 2011, pp. 28; Lynch, et al., 2010, pp. 56). The location and the pattern of the radiation, physical sensation and intensity, frequency, and the duration of the pain are the initial elements of the pain history. Date of onset, proximate cause, exacerbating and mitigating factors and activities as related to the pain are additional historical points that can be realized through the MPQ. I would also administer the Wisconsin Brief Pain Questionnaire that consists of 17 questions and catalogs not only the information captured by the MPQ but also a history of the pain and its effects on mood and activity (Holstege et al., 2008, pp. 96; Micheo, 2010, pp. 16).
As the patient as well as his family had disclosed that he had a heart problem, I would first establish to condition of his heart and administer the necessary measures based on the results.

Question 3: Style of Communication by Ms Bell
Jennifer Bell had poor communication or rather interpersonal skills. She was rude to the client. After been told that the client had used Panadeine Forte, (a painkiller) to ease his pain, she replied that he should have taken some more. This is not an appropriate manner of answering or rather responding to a patient (Albarran and Tagney, 2008, pp. 105).
She did not listen to the explanations that were offered by the patient’s family members. For instance, they did not pay attention to the fact that the patient had a heart problem. Chrisoula notes that “they did not appear to acknowledge the fact this fact nor the medications that Mrs. Markantonakis told them about which were by the side of Mr. Markantonakis’ bed” (pp. 6). While in the kitchen, Jenniffer Bell nonverbally ‘said’ that Mr. Markantonakis was exaggerating his pain (pp. 3). According to the Mrs.Markantonakis and her daughter, the ambulance staff had a bad attitude towards the patient as well as his family (pp. 4).
While in the ambulance, Ms Bell was rude to the patient. She could be heard telling him “stop it be quiet” (pp. 6). Healthcare professionals should not be harsh when dealing with their patients (Norlander, 2008, pp. 66; Carr et al., 2009, pp. 102). This hinders the patient form expressing himself thus unable to unveil all the aspects of his pain which could have been important in managing the pain effectively. Poor communication is also exhibited when Ms Bell failed to report the problems that the patient had developed en route to hospital i.e. suprapubic and epigastric pain (pp. 22).

The strategies she should have applied are:
– Listening properly
– Identifying the nonverbal cues used by the client
– Proper diction i.e. choice of words
– Transparency
– Establishing a good environment

Question 4
The handing over strategy at the hospital could have been improved by providing all the information that the nurse at the reception required. This comprises of the condition of the client i.e. his history. Ms Bell should have disclosed all the information that she had gathered about the patient. A s aforementioned, she did not disclose the complications that the patient developed en route the hospital. Such information would have been used in granting the patient priority as far as getting immediate medical attention is concerned. Additionally, Ms. Bell should have allowed the patient’s family to disclose all the information that they knew about the patient to the receptionist. Alternatively, the nurse should have chosen to question the patient’s family members on issues about the health of the client (Sheppard, 1991, pp. 66; Wright, 2007, pp. 25). By so doing, she could have established the truth and awarded the patient the medical priority or rather care that he needed. Moreover, the nurse should not have made any assumptions about the health condition of the patient. She kept on telling his family that he was next on line since she thought that he was not in a serious medical condition that required immediate intervention.

Question 5:
There was no much assessment done on the patient other than knowing the location of the pain. There were inadequacies in the pain assessment. The quality of pain perceived is determined by the physiological, psychological, emotional and cognitive variables. This means that pain is a biophysical phenomenon (Koestler and Myers, 2002, pp. 26). Some of the impacts that are associated with patient’s pain assessment may include reluctance to involve the patient in their pain assessment or disbelief of their pain assessment. This may lead to inaccurate recording of the pain score, which may result to inadequate analgesia and persistence /recurrence of the pain. As a result of a vicious circle of pain, disbelief and inadequate analgesia evolves. Inadequacies in pain assessment may also occur due to subjective assessments of pain made by the staff rather than the patient (Parsons and Preece, 2010, pp. 96; D’Arcy, 2009, pp. 96). Although the basic principle is that the individual should make the assessment of their pain, healthcare professionals within the multidisciplinary team must be familiar with the patient-centered barriers to achieve the best results for the well-being of the patient. Since pain is a biophysical phenomenon and is subjective, it is important to bear in mind that when assessing the patient’s pain, healthcare practitioners cannot make assumptions on how much pain another person is feeling (Jansen, 2008, pp. 12; Holstege et al., 2008, pp. 362). Other determinants that may positively or negatively influence the experience of pain include anxiety and perceived control over the pain.

My intervention plan would have the following components:
1. Pharmacologic intervention
– Pain assessment would be done by utilizing a numerical rating scale before and after intervention (0-10 scale).
– Use analgesic medications
– Assessment of the pain
– If after doing several pain assessment tests the pain has not disappeared, I would introduce the non pharmacologic treatments given below
– Physical therapy: This provides numerous options for pain management. I would let the patient know that various methods of the physical therapy can improve function and mobility and that a series of therapy may be beneficial. Older patients in particular can benefit from physical therapy in many ways (Twycross, 2009, p. 63). Muscle strengthening, balance, and gait are useful in preventing limited mobility.
– Exercises are also fundamental in the improvement of pain over time. Exercise enhance the relieving of pain since it helps in improving the range of motion, thus increasing strength and power. All exercise would be tailored to improve strength, flexibility and endurance.
– Aqua therapy would also be used in relieving pain.
– Cognitive and behavior strategies would also used in assisting the patient gain normalcy (Winterowd 2000, pp. 215)
2. Pharmacologic therapy
This is one of the most common therapy used for pain management in older adults. This entails the use of drugs. I would use two or more drugs. Research has shown that a combination of two or more drugs may have complimentary or synergic effect with less risk of adverse reactions or toxicity than a higher dose of single drug (Monga and Grabois, 2002, pp. 102). I would use NSAIDS and antidepressants.

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Aging Issues Journal Critical Thinking

Aging Issues Journal Critical Thinking

Entry One: When I Am Old, I Shall Wear Purple
The first thing I thought of when I considered the idea of aging issues was a poem by Jenny Joseph, who wrote Warning, the first lines of which are, “When I am an old woman I shall wear purple/ With a red hat which doesn’t go and doesn’t suit me” (Sachteleben 2009). Joseph was born in 1932 in England composed this ode to being elderly in 1961. Although she grew up in a different generation, Joseph’s poem still resonates. In some ways, there is a certain freedom for the elderly. Many people spend their younger lives trying to do the right thing, have the perfect family, wear stylish clothing modeled after what is in magazines or by celebrities; in other words, they do their best to do what everyone else expects them to do. Joseph appears to believe that this adherence to convention is not necessary for the elderly.
An interesting part of this poem is that it is written by a younger woman, who asks, “But maybe I ought to practise a little now?” about the eccentric activities she mentions within the poem (Sachteleben 2009). Therefore, this poem does not represent the view of an older woman, but a younger woman’s expectation of what she looks forward to when it comes to aging. This poem reflects a very positive view of aging. There are no fears reflected about the future, such as medical issues, having to go to a nursing home, loss of family members, feeling abandoned, and so on. The poet really looks forward to what she believes aging will bring to her, a freedom from the convention and restrictions society places on people.
The question remains of why the poem is titled Warning rather than Happy Times Ahead or something similar. The answer is that the poet is warning others about what she is going to be like when she is an old woman, eccentric and free-spirited. There is a carpe diem theme to the poem for both the young and the old.
This poem is also part of the foundation of the Red Hat Society, which is an “international society dedicated to reshaping the way women are viewed in today’s culture,” and its members are 50 years of age or older (“Our Passion” n.d.). Sue Ellen, the founder of the Red Hat Society, read the poem by Jenny Joseph and was then inspired to create a group for women to help them to enjoy and celebrate becoming older.

Entry Two: In the Movies
The 1990 movie, Strangers in Good Company, directed by Cynthia Scott, tells the story of a group of elderly woman who are traveling in a small school bus which breaks down in the Canadian wilderness. They are lucky enough to find an old, empty house as shelter, but they have very little food or other items with them. However, the derelict house has been abandoned for years, there are no neighbors, and no means to communicate with the outside world like phones.
This movie does a wonderful job of depicting many aspects of aging, both positive and negative. Because there is little to do, the women spend a lot of time in conversation, often in pairs, discussing their past and personal lives. They have a lot of humor about their situation. For example, when the bus first breaks down, one of them says, “I don’t believe I’m walking around in the woods with all these old . . . I mean, this has got to be a sight for sore eyes!” and everyone laughs (Scott 1990). Some of them express regrets about their past, such as never finishing their educations and having to go to work at age 14 to help the family or not developing artistic talents because they felt they had to give it up for motherhood. Some of the freedom of Jenny Joseph’s poem Warning is reflected in their conversation, for instance when Cissy asks Mary about the loves in her life and Mary reveals she is a lesbian, there is no judgment made. Mary says, “It was very hard in my generation, we were the secret generation,” and admits she could not write about it until she was 60 years old (Scott 1990). The women laugh about the medications they have to take, and though they are strangers to each other in the beginning of the movie, quickly become friends.
However, not all of the issues the women face are easy. Beth does not share Cissy or Mary’s ability to feel free and open about herself and is extremely self conscious about her appearance. She insists on wearing a wig because of her shame about how her hair looks now that she is older, and is very surprised when Michelle, who is age 27, tells her that she hopes she looks as good as Beth does when she is her age.
The elderly women have fears. Some of them fear death. Others express fears about losing everything, being destitute, and being wanted by no one. Yet, they also have hopes. In a conversation in which they recount the first time they fell in love, the women ask each other if they would want to fall in love again. One says, “Why not? We still have our hopes, dreams,” and another says, “You’re still alive,” while a third adds, “I still have feelings” (Scott 1990).
This movie does an excellent job of showing the complexity of the lives and personhoods of the elderly. As commentator Lois LaCivita Nixon writes, “Stereotypical impressions of the old, especially those that suggest they are uniformly feeble and uninteresting, are dispelled” (1997). This is a point that many people unfortunately forget, that the elderly are not all the same and boring. When I was growing up, one of my favorite things to do was to visit an old woman neighbor. Unlike many of the other adults in my life, she always had time to talk with me. At my young age, it was hard for me to imagine her ever being my own age. She took joy in showing me her photographs, asking me about the things I liked to do, comparing our favorite things, and teaching me new things. I was reminded of her and the hours I spent conversing with or just sitting quietly with her when I watched Strangers in Good Company.
Many of the issues the women face in the movie are not unique to aging, such as the idea of wanting to fall in love again. However. it highlights another aspect of aging, which is that the elderly are often marginalized as no longer capable of doing much that is worthwhile in society. Yet, the women in the movie are capable, creative, determined people with a lifetime of knowledge.

Entry Three: Older Workers in the Job Market
Two articles about older workers in the job market present different views about the situation. A February 2013 article from AARP magazine presents a positive view and advice to people aged 50 and up about how best to tackle the job market. In this article, the writer says, “It’s often hard for employers to replace the wide skill set of an experienced worker with that of a new college graduate with little to no work experience” (Setzfand 2013). This statement makes it sound as if older workers with more experience have a clear advantage over recent college graduates. The article also answers the question of whether not a career change later in life is a good thing to try with the advice that “it may be the smartest course of action if you’re in a dying field” (Setzfand 2013). This situation is easy to imagine, since many people aged 50 and up once held jobs in places such as factories, coal mines, or other industries which are either no longer in demand or manual labor has been replaced by machinery.
The second article discusses the frustrations of older workers who are searching for jobs. This article starts by describing the trials of a man named Ron Pierson who spent over 30 years in the hotel and restaurant industry before losing his job. It has been two years since he lost that job, and despite his attempts, he has been unable to secure employment. Pierson understands the recession plays a part in the difficulty of finding a job, but he also believes that his lengthy job experience is also hurting his ability to find employment. Reasons the article cites for the difficulties older workers face include not having enough knowledge about the latest technology or trends, employers not wanting to spend money training an employee who will retire soon, and employers not wanting to pay the salary worker a more experienced older worker commands (Linn 2010).
That these two articles contrast each other is not surprising. The point of the AARP article was encourage older workers to keep trying and offer advice on positive steps to take when looking for employment. It is a positive article with a valuable message because it doesn’t just discuss the problems of finding work for older people, but also offers sound solutions to combat some of the problems. Interestingly, it does not mention brushing up on technology skills but seems to assume that older workers today probably have those skills, because it mentions a variety of websites to consult as well as social networks like LinkedIn.
While many older workers may need to find work in order to maintain homes, health insurance, and so forth, another issue is the matter of pride and self-worth. As Ron Pierson said about his long and fruitless job search, he not only needs to work in order to support himself and his family, but he also says, “I need it mentally and physically, in that order. I need a challenge. I need to excel. I need to be proud of myself again” (Linn 2010).
After viewing a movie like Strangers in Good Company and seeing the capable ways of the women and reading the two articles on older workers, it seems as if when it comes to aging, society needs to put more thought and effort into finding a place for older workers. A culture that worships youth and appears to prefer getting things cheaply rather than quality is one that will have difficulty appreciating the contributions older people can make to society. The AARP article mentions its awards program for “Best Employers for Workers Over 50” as well as their “Work Reimagined” program via LinkedIn where over 160 employers pledged that they value older workers and are ready to hire them (Setzfand 2013). This is a very positive step and a growing need for the increasing aging population of the world; however, in order to make things really work, this type of cause and attitude need to be adopted by more than just AARP and similar groups.

Entry Four: Caregiver Stress
As the average age of the population of the nation increases, the problem of caregiver stress will also increase. The U.S. Department of Health and Human Services (HHS) defines a caregiver as “anyone who provides help to another person in need,” most commonly an adult child caring for an elderly parent (2008). According to the Caregiver Stress Fact Sheet, typical feelings of stress come from dealing with difficult symptoms of dementia, feelings of guilt because the caregiver believes she is not doing a good enough job, feelings of loneliness due to decreased time for a social life, and exhaustion from time and effort spend caregiving. The fact sheet offers many suggestions about how to deal with the stress, including asking for and accepting help, being able to say no to things like hosting holiday events, setting realistic goals, reaching out to community resources, taking a break from caregiving, how to pay for costs relating to caregiving, and more (HHS 2008).
While these issues are very important and the suggestions are apt, after talking to a woman who is a caregiver for her elderly mother, another stress factor is important to bring up that the fact sheet did not raise. For her, the most difficult and stressful aspect of being a caregiver was learning to maneuver and navigate the health care system. In her experience, it is of the utmost importance for a patient to have an advocate to deal with the health care system, and she felt this was her primary role. Doctors do not always have the time to spend with the patient or advocate for the patient, therefore this role falls to the caregiver. As an example, she discussed one of her mother’s hospitalizations in which her mother could not form coherent sentences or take care of basic needs like going to the bathroom. The doctors did not see a problem because they assumed that was just the way her mother was because she was old. However, it turns out that the real problem was her mother was having a bad reaction to a particular medication she was prescribed. If the woman had not been there as a caregiver, keeping a daily journal of medicines, procedures, symptoms, and so forth, her mother could have continued to deteriorate or even die because of receiving incorrect medical care. Dealing with doctors who were not always agreeable to the input of non-medical staff was also stressful.
In addition, another issue she had to deal with that is not mentioned in the fact sheet is the stress of having to deal with helping her mother make a change in living conditions. This began when her mother was still able to live at home, but required a visiting nurse (VN) to come in and assist her. It was again an issue when her mother could no longer live at home but needed to be moved to a nursing home because she needed full time supervision and care. It was very difficult to get her mother to accept help because in her mother’s generation, they value independence above all else. Finally, a larger issue for this caretaker is that she often had to help from a distance. In order to ensure her mother received good care, keeping in contact with family, friends, doctors, the VN, other health care professionals, making arrangements for transportation to doctors, and so on was very stressful when she could not be there herself. As a result, the woman has made detailed plans and directions concerning herself for her future caretakers so that some of the issues that caused stress for her can be alleviated for those who care for her in the future.

Entry Five: On Television
The television show Golden Girls is a sitcom that depicts the lives of four older women, all of whom are either divorced or widowed, and now live together as roommates in Miami, Florida (IMDb n.d.). Although I had never seen the show before, I had heard positive things about it and its actresses. The episode watched is titled Flu Attack, a story in which three of the women have the flu all at the same time.
The plot of the episode is simple. There is an awards banquet coming up, and the three women who come down with the flu each believe that she deserves to win the award. They are very competitive and cranky with each other as they try to recover enough from their illness to attend the banquet. It is the eldest them, Sophia Petrillo, who does not come down with the flu and has the best-looking date to the banquet that ends up winning the award.
Several issues regarding aging were themes in the show. Perhaps it was because the episode was filmed in 1986, but one of the women was very surprised at being treated by a female doctor. When Dorothy is being fitted for her banquet gown, Sophia accuses her of slouching because she has never gotten over teasing she experienced in fourth grade. Although it is a comic moment, it is a reminder that things that happen to people even in early childhood may have a strong effect on feelings and actions even when much older. The difficulty of finding a date is highlighted when the women discover by a mishap that Blanche was unable to find a date to the banquet. Although she seems very confident about her looks, perhaps physical appearance is a stumbling block for her, like it was for Beth in the movie Strangers in Good Company. Beth was so worried about her appearance as she aged that it often stopped her from doing things she wanted to do; perhaps there is a similar issue for Blanche.
Overall, this episode of the television show Golden Girls did not present any deep issues regarding aging. It is a sitcom designed to entertain and amuse, not provide a serious analysis of aging issues. It is impossible to know from a single episode whether all of the episodes have such a light, frothy view of aging, and more episodes would have to be watched to see if there are any deeper themes or plotlines that regard aging. However, it does present its elderly characters as funny and interesting people full of personality and interests, a very positive characterization of aging.

Entry Five: Advertisements
Advertisements dealing with aging are common on television and magazines. The target audience can be of any age, although some are more specifically aimed at the elderly. The first example is an advertisement from Allure magazine for Olay Total Effects skin cream (2012). The ad depicts actress Thandie Newton, who is about 40 years old, holding the product, and her quote, “Makeup artists use a lot of products to make my skin look its best on set. But at home, I use one easy step” (Olay 2012). Other texts emphasize that this cream is designed to be anti-aging. Judging by the overall content of Allure magazine, the target audience is women aged between 18 to 40 years old. Although men also worry about the effects of aging on their looks, from this advertisement in Allure, it is obvious that skin care product companies want women to become worried about the effects of aging from a very young age. When searching for information about Oil of Olay, I found a quote from a woman named Mehta who said, “When I was 4, I saw a commercial for Oil of Olay and asked my mother to buy it, because I wanted to look younger. When she asked me how much younger I wanted to look, I say, ‘Oh, two?’” The awareness of the need to look younger and prevent aging starts at a very early age.
Other advertisements, such as one for Life Alert featured in the February/March 2013 issue of AARP magazine are specifically targeted at an elderly audience or perhaps the caretakers of the elderly (p. 71). The advertisement features a man receiving medical care with the words “Only Life Alert Saves a Life from a catastrophe Every 11 Minutes!” (AARP 2013, p. 72). Other texts informs about the variety of emergencies Life Alert can help with. This full-page advertisement has very large print, especially the 800 telephone number to call for more information, which could help those who have difficulty reading small print to be able to understand the advertisement. This ad is simple but effective. Independence is a big issue for many elderly people, so if this ad makes it appear as if this is something the user chooses to do as part of taking control of his or her own life, it will be more appealing. Older people who live alone have many worries, and this product seeks to find a solution to help the elderly worry less and to get help if an emergency does occur.
A third ad from the March 2013 issue of Money magazine is for a service, Seniors Helping Seniors. According to this advertisement, participants can “receive substantial financial and emotional rewards” by assisting senior citizens in living in their own homes “by matching them with other loving, caring, compassionate seniors,” by helping seniors with non-medical tasks like shopping, housekeeping, and companionship, and more (Money 2013, p. 39). This advertisement’s target is senior citizens who are able and fit enough to help other seniors with tasks they may no longer be able to do. In comparison to the Life Alert ad, the print is much smaller, so it could be hard for some seniors to read. Also, the only contact information provided are email and web addresses, so the ad appears to be limited to seniors who have Internet access.


Example Of Research Paper On Treatment Of Postpartum Depression

Example Of Research Paper On Treatment Of Postpartum Depression

What Postpartum Depression Is
Postpartum depression is different for everyone and although it has some of the characteristics of other types of disorders – such as anxiety, posttraumatic stress, bipolar, and obsessive-compulsive disorder, it often appears different from these disorders (Rosenberg & Windell, 2009). It is characterized by women feeling like they’re enveloped in darkness for months after childbirth or even during pregnancy. Women who suffer from this disorder lose their sense of self as a new mother and a woman. They have terrible thoughts about their baby and are afraid to talk about these. Moreover, they think that having a baby is a mistake and wish that they can undo things. As well, they feel that they might lose the love of the people around them because they are not good enough at caring for their baby.

Effects of Postpartum Depression on Child Development
A mother who suffers from postpartum depression interacts differently with her child compared to the way that a healthy mother would. As such, research indicates that postpartum depression can affect a child’s development, behavior, and health (Kotin, 2011). Although not all children experience problems as a result of their mother’s depression, research shows that children – particularly boys – of mothers with postpartum depression don’t perform as well on cognitive tasks (e.g. language) as the children of healthy mothers (Kotin, 2011). Moreover, the infants of depressed mothers tend to spend more time crying and fussing than other infants. On the other hand, the infants of intrusive depressed mothers cry less but tend to avoid engaging with their mothers or looking at them. As well, the insecure attachments of infants to their depressed mothers during the late infancy stage can have negative effects when the infant reaches the childhood stage. These negative effects can include hyperactive symptoms; high rates of conduct problems, especially among boys; and anxiety. In addition, postpartum depression can affect the way that the mother uses healthcare resources, which consequently affects the child’s health. In particular, the infants of depressed mothers tend to visit the emergency department more frequently than infants of healthy mothers and they tend to receive less preventive healthcare, such as immunizations.
Although most mothers recover from the baby blues on their own, it is still best to seek medical help and treatment as this disorder can come in severe forms, such as postpartum depression, postpartum anxiety, and postpartum psychosis. In this regard, this paper discusses some of the treatments that are available for postpartum depression and how efficient these treatments are.

Materials and Methods
For the purpose of this research, a review of the existing research will be conducted in order to determine the available treatments for postpartum depression, their efficiency, and their effect on child development. For this review, the researcher will use journal articles, books, and other scholarly sources.

Although medication is traditionally the first-line treatment for postpartum depression, studies suggest that therapy may be a better choice (Phillips, 2011). In a meta-analysis conducted by researchers from the University of Iowa, it was found that psychotherapy should be considered the first-line of treatment for postpartum depression instead of as a supplement to medication (Philips, 2011). While medication is helpful when needed, many women end up taking the wrong medication or taking it even when they don’t need it. Moreover, using medication as the first-line of treatment deprives these women of the opportunity to consider other options, especially since some women would like to avoid taking medications, particularly when they are pregnant or are nursing. For some women, having a place to talk and receive coping strategies is enough for them to be treated.
In this regard, individual psychotherapy was found to be effective in four randomized controlled trials, particularly those conducted by Appleby and colleagues in 1997; Cooper and Murray in 1997; Holden and colleagues in 1989; and O’Hara and colleagues in 2000 (Gjerdingen, 2003). Studies also showed that better results were achieved when the women’s partners participated in several of the psychotherapy sessions, as these women obtained lower Edinburgh Postnatal Depression Scores (Gjerdingen, 2003).
According to Leitch (2002), the Interpersonal Therapy (IPT), “is the best studied psychotherapeutic treatment for women with postpartum depression” (Leitch, 2002, p. 12). This form of therapy addresses both the interpersonal relationship disruptions and the depressive symptoms caused by postpartum depression. It consists of both cognitive-behavioral counseling and non-directive counseling. The former consists of giving advice about ways to improve one’s mood, about practical support, and about childcare while the latter involves supportive listening without intervention or advice. In a study that tested the efficacy of this treatment method, the results showed a dramatic decrease in the participants’ depressive symptoms after twelve weeks, which implied that this form of therapy can be an effective alternative to medication, especially when the mother is breastfeeding (Leitch, 2002).
On the other hand, the clinical trials conducted to determine the effectiveness of group therapy showed mixed results, which could be attributed to the differences in the structure and content of the group therapy sessions. These included the trials conducted by Chen and colleagues in 2000; Fleming and colleagues in 1992; and Meager & Milgrom in 1996 (Gjerdingen, 2003).
If medication is needed then antidepressant treatment can be employed, as antidepressant drugs have been found to be effective in the treatment of general depression (Gjerdingen, 2003). However, despite newer antidepressants — such as the selective serotonin reuptake inhibitors (SSRIs) — having the same level of effectiveness as the older TCAs (tricyclic antidepressants), doctors prefer SSRIs for the treatment of depression because of their relative safety in the event of an overdose and because of their greater tolerability (Gjerdingen, 2003). The side effects of SSRIs include increased sweating, sexual dysfunction, drowsiness, insomnia, nervousness, anxiety, headache, diarrhea, anorexia, and nausea while the side effects of TCAs include orthostatic hypotension, sedation, weight gain, and anticholinergic effects (Gjerdingen, 2003).
For the treatment of postpartum depression, in particular, uncontrolled studies have found antidepressants to alleviate postpartum depressive symptoms after the intake of antidepressant drugs such as venlafaxine, fluvoxamine, and sertraline (Gjerdingen, 2003). However, since it’s possible to recover from depression over time even without treatment, it cannot be determined for certain whether the depressive symptoms improved because of the drugs or because of other factors. Nevertheless, the findings of a controlled study indicated that antidepressant drug therapy was effective in the treatment of postpartum depression (Gjerdingen, 2003). In particular, the results of this study showed that the participants who took fluoxitone achieved better results than those who did not and that those who attended six counseling sessions showed more improvement than those who attended only one session (Gjerdingen, 2003). However, the study showed that the combination of the antidepressant treatment with the multiple counseling sessions had no added benefit.
For mothers who are breastfeeding while undergoing antidepressant drug treatment, studies have shown that the serum levels of the antidepressant drugs in infants were either very low or undetectable (Gjerdingen, 2003). There were very few instances when the mother’s intake of such drugs had adverse effects on the infant. In one instance, there were relatively high levels of nefazodone in the infant and in three other instances, there were very high levels of fluoxetine in the infants (Gjerdingen, 2003). The adverse effects in these infants included colic, diarrhea, vomiting, and increased crying. Moreover, the infant with a high level of fluoxetine experienced decreased sleep while the infants with high levels of nefazodone experienced poor feeding, hypothermia, lethargy, and drowsiness. In addition, adverse effects were seen in infants whose mothers took doxepin and citalopram.
However, although antidepressant treatment poses risks for the child, not being treated for depression also poses risks for both the mother and the child. As such, the risks and the potential benefits of the treatment must be carefully considered. In the event that the potential benefits outweigh the risks, experts recommend starting out the drug treatment with nortriptyline, sertraline, and paroxetine, as no adverse effects on the infants have been observed from the mother’s intake of these drugs (Gjerdingen, 2003). In contrast, experts recommend avoiding the intake of fluoxetine and being cautious with the intake of nefazodone, doxepin, and citalopram, as these drugs have been found to have adverse effects on infants (Gjerdingen, 2003). Experts further suggest starting the treatment with SSRI as it is easy to administer and contains a low level of toxicity (Gjerdingen, 2003). They also recommend continuing this treatment for six to eight weeks upon the positive response of the patient (Gjerdingen, 2003). Moreover, they recommend continuing intake at the same dose for at least six months after the patient achieves full remission (Gjerdingen, 2003). Still, hormonal treatment can be administered as childbirth causes dramatic hormonal shifts in women. In particular, the daily administration of transdermal 17β-estradiol has been found to result in the decrease of depressive symptoms while estrogen therapy had also been shown to effectively treat postpartum psychosis (Gjerdingen, 2003). However, progesterone was determined to be ineffective in treating postpartum depression and could even have negative effects. Similarly, more research is necessary in determining the safety in employing estrogen therapy as treatment, as increased estrogen can cause thromboemboli or decreased milk production in breastfeeding mothers (Gjerdingen, 2003).
Finally, nurse home visits are another effective treatment for postpartum depression. In particular, studies in Europe showed that weekly counseling visits by a clinic nurse to provide support for depressed mothers resulted in a higher rate of postpartum depression recovery where 80% of those who received counseling visits recovered while only 25% of those who did not receive counseling visits recovered (Gjerdingen, 2003). Similar positive outcomes were also obtained from another nurse home visit program where the nurse facilitated the mother’s access to community services, provided guidance on problems with childcare, and reinforced successes (Gjerdingen, 2003).

This paper briefly described postpartum depression and its adverse effects on both the mother and the child. In the discussion of the possible treatments for this disorder, it was shown that both psychotherapy and drug treatment are effective methods of treatment. However, since drug treatment carries some risks for both the mother and the child, especially when the mother is breastfeeding, experts suggest that psychotherapy be used as a front-line treatment for postpartum depression as not all mothers who are suffering from this disorder need medication and so that they can be provided with alternative options before considering medication.

Gjerdingen, D. (2003, September-October). The effectiveness of various postpartum depression
treatments and the impact of antidepressant drugs on nursing infants. Journal of the
American Board of Family Practice, 16(5), 372-382.
Kotin, G. (2011). A pediatrician’s perspective. In S. S. Bennett (2011), Postpartum depression
for dummies. Hoboken, NJ: John Wiley & Sons.
Leitch, S. (2002, December). Postpartum depression: A review of the literature. St. Thomas,
Ontario: Elgin-St. Thomas Health Unit.
Phillips, M. L. (2011). Treating postpartum depression. Monitor on Psychology, 42(2), 46-48.
Rosenberg, R. & Windell, J. (2009). Conquering postpartum depression: A proven plan for
recovery. Cambridge, MA; Da Capo Press.


Nursing Research Proposal Research Paper Examples

Nursing Research Proposal Research Paper Examples

Implementing a Diabetic Education Program for Patients and Caregivers
Research Questions
Conceptual Framework
Literature Review
Background: Diabetes mellitus is becoming prevalent in the United States of America across all ethnic, socioeconomic, and demographic lines. Precisely, children, elderly people, and pregnant women of childbearing age are at a high-risk of developing the disease. It is the fourth leading cause of death globally, and “currently affects 246 million peoplearound 380 million people will have diabetes by the year 2025” (Ricci-Cabello , Ruiz-Perez, deLabry-Lima & Marquez-Calderon, 2010 p. 572).
Purpose: The purpose of this study is to evaluate the effects of implementing a patient education program with social support for both caregivers and patients within 1, 3 and 6 intervals.
Theoretical framework: Bandura’s theory of self-efficacy supports the hypothesis of this project. According to Albert Bandura, self-efficacy is “rooted in the core belief that one can produce effects by one’s actions. people are significant contributors to their life circumstances not just products of them (Bandura, Caprara, Barbaranelli, Regalia, & Scabini, 2011).
Review of literature: There are many studies that evaluate the effect of caregiver/ patient relationships which the invaluable contributions in the management of diabetes mellitus. Programs have been implemented in the past to develop more effective patient-caregiver relationships, and studies have shown the effectiveness of these programs.

Method (method you are considering):
Results: Pending

Implementing a Diabetic Education Program for Patients and Caregivers
Diabetics who participate in educational programs along with their caregivers have the opportunity to improve patient outcomes as a result of being educated together concerning strategies employed in a DM management care plan. Caregivers are individuals who assist patients with their daily activities and are responsible for their care. Importantly, they are not limited to family members or significant others, but health agencies also provide these services as home health aides and companionship.
The social support provided combining patient and caregivers’ involvement in management of DM proves beneficial towards improving quality of life, well-being and effective adaptation to coping interventions. Diabetics manage their condition better when healthcare providers offer educational programs that teach patients how to design care plans in keeping blood sugar levels under control. The establishment of a diabetic management team, which includes the patient, their primary health care provider and a patient identified caregiver, would also facilitate their education. Patients with social, economic and emotional support from a caregiver benefit from the intervention and develop the ability to control the condition better. Nurses and clinical staff can educate patients and their caregivers empowering both parties to maintain a high quality of care. There are often discrepancies between the health care professionals’ objectives and patients’ goals especially, if he/she is not an active participant in his/her care. Caregivers are in a position to improve social support by increasing their knowledge base through diabetic education regarding the care of DM, the effectiveness of the patient’s involvement as well as the entire family (spouse, children and patient). Nurses play a critical role in resolving many discrepancies in further aligning patient’s goals in management of DM utilizing an effective care management plan.
The question then, is, “How does implementing a DM education program for both patients and caregivers improve patient adherence and outcomes?”

Research Question
In poorly controlled type 2 DM managed through primary care strategies, how does implementing a patient education program with social support for both caregivers and patients promote better outcomes after 1 month, 3 months and 6 months?

Diabetes mellitus is becoming prevalent in the United States of America across all ethnic, socioeconomic, and demographic population boundaries. Precisely, children, elderly people, and pregnant women of childbearing age are at a high-risk of developing the disease. It is the fourth leading cause of death globally, and “currently affects 246 million peoplearound 380 million people will have DM by the year 2025” (Ricci-Cabello , Ruiz-Perez, deLabry-Lima & Marquez-Calderon, 2010). Regarding the incidence some populations are affected more than others. Research has shown more complications, higher mortality rates and more diagnosis for DM “among women, ethnic minorities and people with a low socioeconomic level” (Ricci-Cabello et al, 2010).
More research shows that the national cost of DM in the U.S. in 2007 exceeds $174 billion (Moser, van der Bruggen, Widdershoven & Spreevwenberg, 2008). This estimate includes $116 billion in excess medical expenditures attributed to diabetes, as well as $58 billion in reduced national productivity (Moser et. al, 2008). People with diagnosed DM, on average, have medical expenditures that are approximately 2.3 times higher than the expenditures would be in the absence of DM (Moser et. al, 2008). Approximately $1 in $10 health care dollars is attributed to DM. Indirect costs include increased factors such as absenteeism, reduced productivity, and lost productive capacity due to early mortality (Moser et. al, 2008).
Caregivers provide efficient support in the self-management process of type 2 DM. Their involvement in a patient’s care plans “has a different meaning to each diabetic” (Moser et. al, 2008). Families can contribute in various ways towards enacting these care programs. Caregivers who have been targeted for social support intervention are empowered to produce improved outcomes such as delayed complications and controlled blood sugar levels (Idalski- Carcone, Ellis, Weisz, & Naar-King, 2011).
Further research was conducted to provide evidence that education is valuable in DM self-management. Ka mrath & Timmer (2012) in their Cochrane Collaboration Systematic review stated that education is essential in caring for DM patients (Kamprath & Timmer, 2012). Decrease in the cost of and postponement of complications ought to be the goals embraced by caregiver training programs as they provide matching professional support (Neufeld, Harrison, Hughes & Stewart, 2007).
A treatment plan to increase life expectancy should include reducing the risk for morbidity and mortality, incorporating individualized therapy and “judiciously manages symptoms . while remaining consistent with the patient’s . healthcare preferences” (Cayea, Boyd & Durso, 2007). These preferences need to be detailed, explained and highlighted to the caregivers of DM patients in developing and accessing the optimum program for care. The involvement of diabetic caregivers needs to include taking part in consultancies finding ‘answers to their caring questions to contribute effectively to the diabetes self-management of their kin” (Moser et. al, 2008).
The American Association of Diabetes Educators has identified seven self-care interventions to assist the categorizing of patient’s activities. Interventions are measures taken by a patient to monitor lifestyle ultimately reducing the risk of DM. These include healthy eating, being active, monitoring, taking medication, problem solving, reducing risks and developing healthy coping strategies (Miller, Krusky, Franzen, Cochran, & Zimmerman, 2012). Research shows that the best way to improve diabetic care is through education, and both care givers and patient education should be implemented on the clinical sites, as well in the home setting. (Neufeld, Harrison, Hughes & Stewart, 2007). Further, research conducted by Sinclair, Armes, Randhawa and Bayer (2010) noted that both patient and caregiver diabetes education strategies are require as many as one in seven careers felt regularly overwhelmed and lacked adequate support ( Sinclair, Armes, Randhaw & Bayer, 2010) . By aiming at the improvement of diabetic knowledge to both care givers and patient, management of the condition would be greatly enhanced since the disease affects major organ systems (Miller et.al, 2012)
It is possible to align interventions with the patient’s specific needs. Caregivers and patients must make mutual decisions regarding DM care. This is the only way caregiver/patient diabetes mellitus management programs can be successful. Project Help Educate to Eliminate D.M or HEED “was successful in obtaining significant group differences in weight loss at 12 months” (Kanaya et. al, 2012) in patients with DM. Healthy-Living Partnerships to Prevent Diabetes (Help PO), is another community-based translation program that found reductions in fasting glucose levels offered to well-educated patients of high risk (Kanaya et. al, 2012).
Live Well, Be Well is a translation program that produced favorable outcomes. The researcher utilized telephone-based models in the study (Kanaya et.al, 2010). It allowed participants in minority communities to work with local clinically based experts providing interventions through text messaging. This ultimately helped reduce the incidence of diabetes mellitus complications by managing the condition more effectively. It was a translation evidence based strategy with priorities focused on vulnerable understudied groups, offered generalizable information, developed partnerships between researchers and local public health departments. The translation process was organized for sustainability being designed and managed within the public health department’s chronic disease prevention program (Kanaya et.al, 2010).
Similar translation strategies are expected to be adapted in this intervention. A care giver support group to improve patients’ outcomes will be designed and thereafter known as the patient/caregiver team (Miller, Krusky, Franzen, Cochran, & Zimmerman, 2012). In conducting this study, patients with caregivers will be recruited from a primary care practice community office visit setting. Office visits will be scheduled at weekly intervals. To evaluate effectiveness of the program patient outcomes including blood sugar levels, blood pressure, weight control and predispositions to complications will be evaluated over a six month interval.
It would involve an intense patient education program, which forms the core of translation of evidence into practice. Precisely, specific needs of each patient/care giver team will be identified during interviews weekly. Responses to the intervention will be recorded from the patents’ perspective as well as care giver. Caregiver stress levels will be evaluated using a likert scale 1-5 for recording levels of stress (Intense, moderate, mild, none, cannot decide).

Conceptual Framework
The theoretical basis of this nursing research is guided by Albert Bandura’s theory of self-efficacy. According to Albert Bandura, self-efficacy is “rooted in the core belief that one can produce effects by one’s actions. people are significant contributors to their life circumstances not just products of them” (Bandura, Caprara, Barbaranelli, Regalia, & Scabini, 2011). Caregivers are expected to involve patients in planning the self-care process. Bandura and colleagues argue that an individual’s self-efficacy plays a major role in how goals are achieved, tasks executed, and challenges approached (Bandura et.al, 2011). Others have contended that caregivers should encourage self-management support (SMS). This is considered “a cornerstone of chronic disease care encompassing such strategies as individualized assessment, collaborative goal-setting, skills enhancement, access to resources and continuity of care” (Schillinger, Handley, Wang & Hammer, 2009). Family based interventions were reviewed in a study by Keogh (2007) to highlight strategies for improving outcomes for patients with uncontrolled type 2 D.M. The researchers found that family members caregivers “may influence outcomes in physical health by means of a psychological and/or health behavior pathway” (Keogh et. al, 2007).
It must be understood that when family members take on the caregiver‘s responsibility they can become overwhelmed in caring for the person. Factors associated with the caregiver burden syndrome are “the care recipient’s disabled state, the measureable observed variables of MFS, PGC scale, caregiver’s age, care self-efficacy, having a cooperator, spouse caregiver and the J-ZbI-8 (caregiver burden)” (Makizako et. al, 2009). Theorists agree those caregivers’ goals “are to achieve the maximum longevity consistent with an optimal quality of life” (Cayea, Boyd, Burso, 2007).

Literature Review
Caregiver/ patient relationships have repeatedly shown their invaluable quality in the management of DM Programs have been implemented in the past to develop more effective patient-caregiver relationships, and studies have shown the effectiveness of these programs. However, there are studies showing how implementing a diabetic education program for both patients and caregivers can improve patient adherence and outcomes.
Already it is known that with efficient caregivers, self- management of DM can be more effective. Studies on DM self-management with care giver input have indicated immense improvement in outcomes. Importantly, Cohen, Christensen, & Feldman (2012) examined methods that disease management organizations can adopt in increasing adherence to self-management techniques. Precisely, the study measured effectiveness of adherence programs targeting chronic illness including DM. Investigations reviewed whether adherence strategies are being coordinated with payers’ use of value-based insurance design, in which patient cost sharing a function of the relative value of pharmaceuticals. The results suggested that disease management might be falling short in terms of comprehensive commitment to expert recommended at-home devices used to self-diagnose and measure health indicators (Cohen, Christensen, & Feldman, 2012).
It also involved early adoption of expert-recommended new technologies to measure and improve adherence, and intensity use of standard tests in outpatient clinics. Therefore, this study provided data concerning incorporating technologies in arriving at as well as measuring outcomes (Cohen, Christensen, & Feldman, 2012). Similarly, Kim, Love, Quistberg, & Shea (2004) reviewed how literacy influences compliance with care guideline. Researchers contend that there is limited health literacy among diabetics. They performed a literacy analysis during a prospective observational study. It was observed after 3 months trial that diabetes education was effective in improving self-management, knowledge, and glycemic control for patients with adequate and limited health literacy. Further observations were that by expanding educational programs in cases of low literacy disparities in DM outcomes may be narrowed (Kim, Love, Quistberg, & Shea, 2004).
A startling discovery, however, was that after 3 months of education intervention diabetics with lower literacy showed more adherence to self-management techniques than those which begun the program with a higher literacy level. The conclusion was that ‘reinforcement of previously taught behaviors may have led to greater improvement in the limited literacy
Group’ (Kim et.al, 2004). Likewise, Khan, Al-Abdul Lateef, Al Aithan, Bu-Khamseen, Ibrahim, & Khan (2012) researched non-compliance/adherence to diabetic self-management among patients in Saudi Arabia. They discovered that there was a high noncompliance rate due to lack of education. Of 535 patients enrolled in this cross sectional study, the noncompliance rate was 67.9%. However there was a significant difference between noncompliant and compliance among patients with varying levels of education. They concluded that education has a strong influence in adherence to diabetic self-management programs (Khan, Al-Abdul Lateef, Al Aithan, Bu-Khamseen, Ibrahim, & Khan, 2012).
Subsequently, Keyvanara, Hosseini, Emami’s (2012) study assessed how social support is related to the control of DM. The findings of this research showed where social support in diabetic care could result in low blood sugar, favorable self-care behaviors and decreasing depression. Further the researchers showed that there is a positive relationship between social support and control of DM. The patients with better instrumental, emotional, informational social support had better controlled DM (Keyvanara, Hosseini & Emami, 2012)
Yet in another study conducted by Sinclair, Armes, Randhawa, Bayer (2010) where they interviewed caregivers of diabetics, it was observed that patient and caregiver knowledge of DM was inadequate in producing favorable outcomes. Often education and training provided very important strategies in resolving adherence issues and arriving at more favorable outcomes (Sinclair, Armes, Randhawa & Bayer, 2010). Likewise, Hirakawa, Kuzuya, Masuda, Enoki and Iguchi, (2008) conducted studies showing the influence of diabetes mellitus support management on caregivers within the community among frail elderly diabetics. Support management of DM was not overwhelming to these caregivers. Findings also proved that there was no difference between male and female caregivers with respect to expressing stress due to execution of their duties (Hirakawa, Kuzuya, Masuda, Enoki and Iguchi, 2008)
Alternatively, further research has revealed that DM caregivers play an important role in endorsing self-management skills. Keogh, White, Smith, McGilloway and O’Dowd’s (2007) study assessed the effectiveness of education on poorly controlled DMpatients and caregivers. The study determined how to improve patients’ outcomes by nominating family member’s participation, following up with a phone call, and developing personalized action plans to improve diabetes management. Results were that of the 230 participants, there was a retention rate of 92%. ‘6-month group differences for weight and triglycerides were significant. The intervention group lost 2 pounds more than did the control group (P=.03) and had decreased triglyceride levels (difference in change, 23 mg/dL; P=.02). At 6 months, the intervention group consumed 7.7 fewer grams per day of fat (P=.05) and more fruits and vegetables (P=.02) than did control participants (Keogh, White, Smith, McGilloway & O’Dowd, 2007).
The purpose of Bandura, Caprara, Barbaranelli, Regalia & Scabini (2011) study was to assess the effectiveness of self-efficacy on the family as a whole. The study result showed that the family is efficacious if patients are self-reliant in their care management plan (Bandura, Caprara, Barbaranelli, Regalia & Scabini, 2011). Educational and support interventions are important for managing DM according to the Konradsdottir and Svavarsdottir (2011). This study assessed the effectiveness of short-term educational and support interventions for families of an adolescent with type 1 DM. The study reviewed the adaptation and coping strategies of parents who had adolescents with DM and the effect of a short-term educational and support intervention. The short-term education and support intervention consisted of three sessions namely, educational lectures, support interviews for the parents and support groups for the adolescents. A significant difference was found between parents’ coping patterns before and after the intervention. These results suggest that mothers and fathers use different coping patterns when coping with their adolescents’ chronic illnesses (Konradsdottir & Svavarsdottir, 2011).

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Heuristic Meaning Through Suffering Research Paper Examples

Heuristic Meaning Through Suffering Research Paper Examples

Conclusion and Summary of Results
The focus of this study was to explore a Black woman’s resiliency after her exposure to a physiological and psychological toxic work environment. The work environment surrounding an African-American woman can often be a source of distress because of the way her colleagues and others treat her. For example, many Black women are treated as if they are a stereotype; a caricature of what people assume is a “black woman.” Micro-aggressions experienced each day become magnified as emotional assaults on the woman increase; or, as her ability to deflect the inappropriate behavior decreases or as the intensity of both becomes greater. The stereotyping and micro-aggressions caused destructive feelings in the subject of this case study, which exhibited themselves as isolation, oppression, and shame. This trio of feelings caused a feeling of disconnectedness, which somewhat ironically created both negative and positive factors. The subject’s natural resiliency was sustained mainly by two main personality character factors: control and passion.
In this case study, the internal control of self was identified as the most important early survival adaption. In childhood, both negative and positive aspects of Control were demonstrated, but the results demonstrated that the positive aspects increased as the negative aspects decreased. In the final analysis, the results showed that the ability of Control became highly developed in the subject and aided her future life successes. This ability for control of self, self-discipline, and Control gave her a necessary positive strategy to use as she matured. She developed her control-of-self so she had a personal strategy to her aid in personal problem solving. Whereas on the other hand, violence was a tool that was learned and served her well at a young age as a survival technique, she was able to shed the impulse to use violence as her life’s environment changed. The subject developed new methods and tools for facing dilemmas rather than resorting to violence.
Unfortunately, in the situation of the toxic work environment this particular skill of control of self had self-defeating results. She was convinced she must practice control of self and stay at a job which was a highly negatively charged environment. Yet, she forgot to take into account the effect on her health. Perhaps, if she could have seen her good health and her financial contributions to the family as both equally important goals she could have left the toxic employment as soon as she realized the difficulties of the situation. Finally, the researcher comes to understand that the subject’s passion coupled with her resiliency could have been predicted to aid her future successes. This included the terrible situation at work because although she tolerated the terrible treatment on-the-job she searched for someone to support her and validate her feelings. The search was not easy, but she did not give up until she found the professional and expert validation she felt she needed at the time. In this case study the three major resulting effects from a toxic work environment were found to be control, passion and disconnectedness. Here they will be discussed in greater detail.
There has been research conducted on African-American women and the reasons they have ‘silenced voices’ even when faced with the enormity of both racism and sexism at work. Jones (2003) explained that Black women’s silenced voices result from relationships that had caused disillusionment leading to isolation, disconnection, and distress during their childhood or youth. One such place has been church, but Jones’ research used women attending the Protestant Black churches as subjects. In this case study the subject was trained in the Catholic religion and felt that her faith was very important to her and necessary to sustain her through her life’s challenges. Jones’ research is still important for informing this case study because of the general insights of cultural challenges that African-American women face in black communities. Regardless of whether or not the religion is Catholic or Protestant, strong religious faith leads to resiliency. The subject’s life is a case in point. Although the subject felt varying degrees of disconnectedness throughout her life development she always had a consistent connection with her faith.
The seeming paradoxes between African-American culture and religious faith lend understanding to the complexity of cultural and relationship experiences throughout a whole lifetime. Relational-Cultural Therapy (RCT) the use of RCT is especially helpful in defining and understanding these complexities in an individual and in societies.
(Relational-Cultural Therapy) . . . sees connection as the primary ongoing organizer and source of motivation in people’s lives that transforms the work of socialization into assisting our children to develop relational skills and elaborating the possibility for mutuality in relationships. It furthermore calls attention to the need to alter the sociopolitical forces of disconnection that create significant pain for people. (Jordan, 2010, p. 1)
This is significant because the continued silence of Black women negatively impacts their overall health ranging from less dangerous symptoms such as fatigue to very serious disease such as cancer. When an African-American woman has an outlet to share her experiences in a therapeutic setting or in research such as this, patterns of experiences can be uncovered such as those learned during childhood which can repeat during a woman’s professional adulthood. The subject of this research in her very early life had a stable and happy life which may have also predicted her ability to mature, continue her learning, and meet her dearest life goals such as having her own family.
The Relational-Cultural Theory (RCT) relationship delineates meaning from the isolation, disconnection, and shame as experienced through the subject’s life phases. The descriptive account of suffering physiological and psychological pain during the life phases suggests an arresting of human development. In the subject’s case, the arrest of her development began in childhood and within the Black community where (and when) she learned self-imposed isolation to manage disconnectedness and shame from authority and demeaning insults. However, her resilience developed into helping relationships that reciprocated emotional healing and posttraumatic growth.

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Government Provided Health Care Research Paper Examples

Government Provided Health Care Research Paper Examples

In the United States, the health care system can be qualified as consisting of a public system and private health insurance providers that caters the health insurance needs of the elderly and low income individuals. According to Johnsons (2009), the Federal government’s Medicaid program serves the disabled and the poor families. The health coverage for the low-income children, pregnant women, disabled, and elderly is taken care by the state government. The Medicaid program also has separate health coverage for the individuals over 65 years old. Also, the State Children’s Health Insurance Program covers the health care of children who belong to family that do not qualify for Medicaid but don’t make enough money to buy private health insurance. The benefits derived from health care covered by the Medicaid differ depending on the kind of insurance but typically include physician visits, outpatient and inpatient services. There are plans that are consisted of dental care, preventive services, and prescription drugs.
Private insurance companies provide the employer-sponsored private insurance services of the Americans. Such health care plans have to accept everyone at the same price. Usually the plans are underwritten based on health history smoking status, weight, and age (Johnsons, 2009).
As to the government’s role in the provision of health care, almost 46 percent of the total spending in health care is from the government (World Health Organization, 2012). In particular the Federal utilizes the tax revenue in reimbursing health care agencies that provide care for patients under the Medicaid, Medicare, VA or SCHIP programs. The government also provides subsidy to employer-based insurance agencies.
In comparing the care system of the US is compared with that of The Netherlands and Japan, it was reported by Johnsons (2009) that among the developed nation, it is only the US that does not provide full access to health care to all its citizens primarily due to the high-end health and expensive features of the health care. Because of the sophisticated facilities and equipment used in the health care services, the government found it very costly to provide the so-called universal health care. Compared to the abovementioned countries, the US government has the biggest spending on health care.
Johnsons (2009) described the health care system as comprising of AWBZ (a universal national social insurance programs for long-term care) under the Exceptional Medical Expenses Act, and health group- plan insurance administered employers. In Netherlands, the government requires all the residents to buy health insurance from the private, not-for-profit or for-profit health insurance companies. The health insurance businesses are found to be very competitive in the country but are highly regulated by the government. The present health care system in the country was established in 2006 through a reform in the health policy. The previous system was comprised of a private health insurance and a social health insurance system. Under the new system, a subsidy is provided by the government to health insurance agencies that cater the insurance needs of elderly, sicker or have pre-existing conditions. Meanwhile, a tax credit is granted to low income patients; and individuals below 18 years are automatically insured without any cost. The coverage of standard insurance benefits includes maternity care, hospitals, general practitioners, medicines, and lab tests. Patients who have purchased more costly insurance plans have the privilege to choose health provider. Relative to the US, the health care system in Netherlands uses private health insurance companies that partly cover the public insurance through government regulation of these companies. Moreover, 80% of the total spending in health services is financed by the federal government (World Health Organization, 2012). The government required standard insurance is a combination of flat-premiums and individual contribution from income earned which is set at 6.5%. The insured individual pays a premium for a policy with flat-rate. The same policy is paid with the same premium; and residents who belong to the lower income group are given healthcare allowances by the government to help them in their healthcare insurance payments.
Meanwhile in Japan, being the first country in Asia to establish a comprehensive social insurance program, the government requires all of its citizens to obtain health insurance (Johnsons, 2009). The health insurance can be obtained either through the national health care program or through the employer-based health insurance. The insurance companies are non-profit companies hence there is no competence in the health insurance industry. The government intervenes by ensuring the fixed prices of the insurances and negotiating insurance rates with the health care industry every two years. Also, patients have full access to all the health institutions in the country. The healthcare services that are covered by the Japanese healthcare system include prosthetics, home nursing, home care, outpatient care, prescriptions, dental, long term care, and home nursing for the elderly. It also includes cash benefits that are given to women for their childbirth. There are however costs that are not covered like over the counter drugs, routine physical exams and some of the dental services. Under the employer-health insurance, the premium for the insurance shared by the employer and the employer, of which, about 4% of the employee’s salary is required for the average contribution. Also, before the employee can avail of the full insurance coverage, he/she has to pay around 20-30% of the care costs. Moreover, the participants in the national health insurance pay a premium based on salary and co-payments for the prescription drugs and care. They are also required to pay or share at least 30% of the cost of the health insurance before they can enjoy full coverage. As to the role of the state, the Japanese government’s share in spending for health care is more or less at 81% of the total health expenditure of Japan (World Health Organization, 2012). Relative to the health system of the United States, the socialized health care system of Japan is considered as one of the best performing among countries.
In a report published by OECD (2010), the new dataset on health policies and institutions reveals that: first, across countries, the basic coverage of insurance (in terms of degree of cost sharing for the premium, covered population and services included) is found to be almost similar with the exception of the United States, Mexico and Turkey. The population covered by health care insurance in the three countries are limited. Second, more and more countries rely on the mix of a centralized health care services and regulated market mechanism though there are some OECD economies that have reliance on centralized command-and-control systems in affecting the demand and supply of health care services; and even some have reliance on solely regulated market mechanisms like the fee-for-services, competition driven by user choice and private insurance. And third, the varying policy tools of the government are found to be complementarily working. For example, there are countries that adopt or use command and control health care systems that pay fixed wages relies on standard setting and rules. There are also countries that utilize the fee for service while relying at the same time on private health care providers.
As to spending, there are several identified significant differences in terms of the spending levels and outcome. In particular: first, in countries that rely mostly on market mechanisms, the spending levels are found to be high. The health outcomes include a long life expectancy. Second, there are countries that have high health status inequalities. There are also countries like Germany, Switzerland and The Neatherlands that rely on private insurance and have low level of health status inequality. The differences can be explained partly by the degree of intervention or regulation that the government imposes on the health care sector. Third, in countries where private insurance companies have significant role in the provision of health care insurance, the administrative costs were found to be high. The cost is found to be higher than the OECD average by a considerable margin in France, Belgium, Luxembourg, Mexico and New Zealand, signaling a potential for reducing spending in these countries.
A government provided health care service has both a good side and bad. On one side, a government’s spending on public goods and merits goods like the health care has been viewed to create inefficiency and excess bureaucracy. Most economists believed that government-owned companies tend to lack profit incentive resulting to inefficiency and often leads to misuse of resources. The problem relating to moral hazard is a particular issue associated with government provided health care service. Interventions in the form of subsidies and health insurances only create dependency program among people, that is, people may not bother to take care of their health because they would always expect that the government will always be on assistance.
On the other side of the argument, government-run health services may be better than private health service and insurance providers especially if the government adopts the principle of transparency and accountability.
Nichols (2012) emphasized in his paper that government intervention in the health care markets is practical, necessary and morally sound. He articulated that it is not possible to have a better and sustainable health system in the absence of a government that plays specific yet absolutely crucial roles.
In the United State, the health care system is different from other countries like The Netherlands and Japan because it does not have a universal health care, that is, not all of the population in the country is covered by the health care program of the government. According to Poterba, the federal, state and local governments if the US are direct providers of heath care but of relatively little health care coverage. The health care insurance benefits can be obtained from school or from jobs, or from private health care providers (which is very costly). However, unemployed individuals or non-students do not have access to it. This is one of the obvious limitation and flaw of the US health care system.

Works Cited:
Johnson, James (2009).“Comparing International Health Care Systems” Accessed from http://www.pbs.org/newshour/updates/health/july-dec09/insurance_10-06.html
OECD (2010). “Health care systems: Getting more value for money”, OECD Economics Department Policy Notes, No. 2. Accessed from .
“Accountable Care Organizations” (2011). Accessed from .
Nichols, Len (2012). “Government intervention in heath care market is practical, necessary, and moraaly sound”. DOI: 10.1111/j.1748-720X.2012.00688.x
Poterba, james (1994). “Government intervention in the markets for education and health care: how and why? Accessed from
World Health Organization (2012) at http://www.who.org


An Effective Alternative for Treating Lower Back Pain Wayne State University Health Clinic 5200 Anthony Wayne DriveSuite 115Detroit, MI 48202

An Effective Alternative for Treating Lower Back Pain
Wayne State University Health Clinic 5200 Anthony Wayne DriveSuite 115Detroit, MI 48202

Heliotrope Enterprises
Executive Summary
Lower back pain is a common symptom prompting clinic visits in the University. The standard treatment is pain-relieving medications and rest from exertion but current trends in health care point to the increasing use of complementary and alternative medicine (CAM) in the treatment of lower back pain. The use of CAM is motivated by patients’ desire to avoid the side effects of frequent pain medication use. However, many CAM modalities only result in short-term pain relief which decreases patient satisfaction with these treatments.
The Bowen technique is a promising alternative modality for treating lower back pain. It is deemed effective, especially over time, based on its long use since its development in the 1950s. As such, the Wayne State University Health Clinic commissioned a research project to obtain evidence of Bowen technique efficacy which will be the rationale for adopting the technique as an alternative treatment for patients with lower back pain in the future.
This report presents the results of the study done to establish the efficacy of the Bowen technique based on secondary and primary data. A literature review was undertaken showing that pain relief is experienced in 1-3 treatment sessions and generally is sustained over time. Further, email interviews of 10 randomly selected certified Bowen practitioners in the state were done to see if the treatment is effective specifically for back pain based on their experiences. The main results of the study are as follows:
– There were 428 patients treated for lower back pain in the last year.
– Pain symptoms usually abated within 1-3 sessions in more than 50% of the patients; differences in the number of sessions are due to individual factors.
– Symptom improvement tended to continue over time and majority eventually achieved total lower back pain relief.
– Of those who experienced complete relief from pain, most had no more need of further treatments for lower back pain.
– Slightly more than a third of patients returned for maintenance treatment of lower back pain and is mainly due to reinjury, chronic conditions and noncompliance.
Findings of the primary research corroborate the findings in literature which builds strong evidence for the positive outcomes of the treatment. Thus, the Bowen technique is a safe and effective therapy for lower back pain which should be adopted by the University Health Clinic and combined with patient education to address unrealistic expectations, compliance and prevention of reinjury.

Lower back pain is a major health complaint in the U.S. In its latest report, the CDC reveals a 30% incidence among American adults in a 2009 survey (National Center for Health Statistics, 2010). Lower back pain can significantly affect the performance of daily activities including work. It increases the number of sick days which correspond to lost economic productivity. The experience of pain considerably reduces the quality of life. It is no wonder that there is a high demand for effective treatment of lower back pain. Conventional treatments consist mainly of medications which can threaten health especially when taken long term. Hence, alternative techniques are better options. Although people obtain full pain relief from alternative modalities, the major complaint is that pain comes back after awhile. Therefore, there is interest in finding an alternative technique that provides relief over time.
The Bowen technique is one alternative treatment that is widely utilized today. Its popularity among alternative treatment practitioners and patients alike is largely due to the fact that it is not invasive, has no side effects and provides long-term pain relief compared to other treatments (Lofting, 2003). This is beside the other benefits gained from the technique’s holistic approach. The modality was popularized by the internationally-recognized Bowen Therapy Academy of Australia and is represented in our country by the Bowenwork Academy USA. The technique is presently governed by quality standards achieved through training and accreditation, the latter provided by the Academy in Australia (Bowenwork Academy USA, 2011). Currently, there are 369 accredited Bowen practitioners in the U.S. with 72 based in California, 47 in Washington, 28 in Texas, 26 in Michigan, and 26 in Oregon.
This report concerns an evaluation of the Bowen technique in terms of its efficacy in relieving pain for longer periods. It aims to provide first-hand evidence validating its efficacy over time as stated by patients and practitioners. Hopefully, the results will initiate more research interest on this modality and further establish the technique as a treatment for lower back pain. Specifically, this report will discuss the following:
– Development of the Bowen technique and how it works
– The Bowen technique as an alternative and non-invasive treatment
– Efficacy of the Bowen technique for back pain within 1-3 sessions based on case studies in literature and the results of primary research
– Percentage of patients coming back after pain level reach zero is supported by case studies in literature and the results of primary research
– The second research method
– Future directions for research on the Bowen technique
The evaluation is accomplished through a literature review as secondary research. Case studies and reviews on the outcomes of Bowen technique utilization in various patients were searched and retrieved from reputable websites, as well as from the ScienceDirect and EBSCOhost databases. A search of relevant books from the perspective of health care professionals yielded one for reference. Primary research was done through email interviews of Bowen technique practitioners using a randomly selected sample of those affiliated with the Bowenwork Academy.

Section I. Background of the Bowen Technique
The Bowen technique is internationally recognized as a complementary and alternative medicine (CAM) modality. Specifically, it is a type of body manipulation treatment, a category of CAM which utilizes either pressure, touch or movement of parts of the body as techniques (Snyder & Lindquist, 2006). With the persistent problem of back pain in the population and the costs and side effects of using pain relievers, it is important to widen the options of patients regarding treatment. The following discussion describes how the Bowen technique was developed and how it actually works.

Development of the Bowen Technique
The Bowen technique or Bowenwork is a therapeutic modality utilized for pain relief. Its development was undertaken by Tom Bowen, a masseur who had a long history of treating athletes and laborers in Geelong, Australia (Brief history, 2012). The most common complaint of his patients was body pain owing to their strenuous physical activities. Bowen used his expertise in massage therapy to relieve the pain of his patients. In his extensive practice, he noticed that there seemed to be a connection between the pain symptoms arising from musculoskeletal injury, problems involving the nervous system, and various Fig. 1 Tom Bowen other health conditions (Brief history, 2012).

How the Bowen Technique Works
The soft tissues most relevant to the Bowen technique are those that involve the muscles and nerves. Receptors located in these sites relay messages to the brain setting in motion the body’s natural ability to heal by repairing worn out or injured tissues, efficiently using nutrients, eliminating waste, ensuring adequate blood flow, permitting lymph drainage, keeping nerves healthy, and maintaining adequate muscle length (The Bowenwork, 2012). An important outcome of Bowen therapy is deep relaxation, a state of remarkably reduced stress that sets the stage for healing. Therapy, whose duration may range from as short as 15 minutes to as long as one hour, eventually results in decreased muscle tension, improved ranges of motion, reduced inflammation and relief from pain (The Bowenwork, 2012).
The Bowen technique is characterized by rolling movements aimed to slide skin over the soft tissues that lie beneath (Genders, 2006). These moves are accomplished using the fingers along with the application of light pressure to specific parts of the body that have been delineated by Tom Bowen in his decades of practice as the areas that trigger specific body responses (The Bowenwork, 2012). The use of gentle pressure is the hallmark of the Bowen technique setting it apart from massage therapy which uses deep pressure. The pressure used in Bowen treatment is considered a mild stimulus which contributes to its high efficacy. An explanation for this is provided by the Arndt-Schultz law adapted to Bowenwork from the field of medicine. It states that in an individual, only an ideal amount of stimulation can bring about optimal results and usually, it is minimal stimulation that works better than strong stimulation (Knight & Draper, 2008).

Fig. 2 Different Bowen moves
The moves are followed by a rest period which allows the body to fully respond before the next moves are done (Genders, 2006). Wellness is achieved as treatment draws on the innate power of the body to restore itself leading to an abrupt and often long-term resolution of pain and other symptoms. It also recognizes that individual responses vary so that the practitioner must adjust treatment to accommodate the unique responses of patients and for this reason, patient assessment is done prior to treatment (Marr et al., 2010). Initial therapy usually consists of two sessions held weekly but further sessions may be needed. On the average, it would take three to eight treatment sessions for most health problems to completely resolve (The Bowenwork, 2012). The technique has been noted to be useful in treating more than 60 symptoms and conditions.

Section II. The Bowen Technique as an Alternative Non-Invasive Therapy
Compared to conventional pain therapy, which may be delivered through injections, and other alternative treatments such as acupuncture, the Bowen moves are not invasive. This means that the skin, acting as the body’s major protective barrier from the external environment, is not breached. In contrast, the use of injections to administer medications and the utilization of needles for acupuncture both penetrate the layers of the skin.
When proper infection control procedures are not taken, penetration of the skin can facilitate the entry of harmful microorganisms into the body (Injection safety, 2012). A non-invasive therapy like the Bowen technique has many advantages. First, the possibility of developing infections is zero since the skin is not breached. Second, there is no pain associated with treatment. Third, the likelihood of other complications such as tissue injury is virtually none.

Section III. Literature Review
A search of previous studies on the Bowen technique was done using Cinahl and ScienceDirect journal databases. Search terms used were Bowen technique/therapy/treatment/modality and lower back pain. The studies retrieved describe the efficacy of the Bowen technique specifically for back pain and also the people returning for retreatment due to pain recurrence.

Efficacy of the Bowen Technique for Lower Back Pain
The efficacy of Bowen therapy has been documented in literature. James (2008) documented the case of two older adult patients who benefited from the modality. One had extreme lower back and left hip pain owing to problems with the pelvic bone. He had poor posture and difficulty with movements of his arms and legs. After 30 minutes of initial Bowen treatment, he could stand straight and move with ease minus the pain. The other patient also had chronic lower back pain which limited her activities and subsequently developed depression. After initial treatment, her mood significantly improved along with her pain. Two more treatments totally relieved her pain and stabilized her mood. The study validates the pain-relieving effects of Bowen therapy. These case studies show that Bowen treatment can effect pain relief immediately after the first treatment session and that full resolution of symptoms is achieved during the third treatment.
In her book, Genders (2006) also describes two cases of children with cerebral palsy wherein the Bowen technique was effective. Decreased muscle tone, difficulties with balance and coordination and swallowing problems are some of the physical manifestations of this condition while low attention span, sleep disturbances and delays in speech development are some of the psychological and mental signs. Both children received a series of Bowen treatment sessions which resulted in marked and steady improvements in many of these signs. Most notable is the technique’s capacity to enhance musculoskeletal functioning even among children. The children’s parents were able to notice improvements right after the first treatment, again showing that the effects of Bowen therapy are immediate.